Sentinel lymph nodes in endometrial cancer: is hysteroscopic injection valid?

We aimed to describe hysteroscopic peritumoral tracer injection for detecting sentinel lymph nodes (SLNs) in patients with endometrial cancer and to evaluate tolerance of the procedure, detection rate and location of SLNs. Five patients with early endometrial cancer underwent hysteroscopic radiotracer injection followed by lymphoscintigraphy, then by surgery with hysteroscopic peritumoral blue dye injection, and radioactivity measurement using an endoscopic handheld gamma probe. SLNs and other nodes were sent separately to the pathology laboratory. SLNs were evaluated by hematoxylin-eosin-saffron staining and, when negative, by immunohistochemistry. Tolerance of the injection by the patients was poor (mean Visual analog scale score, 8/10). SLNs were detected in only two patients (external iliac and common iliac+paraaortic, respectively). Detection rates were 1/5 by radiotracer, 1/5 by dye, and 2/5 by the combined method. One SLN was involved in a patient whose other nodes were negative. In three patients no SLNs were found by radiotracer or blue dye. Of the 83 non sentinel nodes removed from these patients, none was involved. Hysteroscopic peritumoral injection may be more difficult than cervical injection and, in our experience, carries a lower SLN detection rate.

Endometrial cancer; Sentinel lymph node; Hysteroscopy; Paraaortic chain

[1] Burke T.W., Levenback C., Tornos C., Morris M., Wharton T., Gershenson D.: “Intraabdominal lymphatic mapping to direct selective pelvic and para-aortic lymphadenectomy in women with high-risk endometrial cancer: result of a pilot study”. Gynecol. Oncol., 1996, 62, 169.

[2] Pelosi E., Arena V., Baudino B., Bello M., Giusti M., Gargiulo T. et al.: “Pre-operative lymphatic mapping and intra-operative sentinel lymph node detection in early stage endometrial cancer”. Nucl. Med. Commun., 2003, 24, 971.

[3] Barranger E., Cortez A., Grahek D., Callard P., Uzan S., Darai E.: “Laparoscopic sentinel node procedure using a combination of patent blue and radiocolloid in women with endometrial cancer”. Ann. Surg. Oncol., 2004, 11, 344.

[4] Bats A.S., Clement D., Larousserie F., Le Frere Belda M.A., Faraggi M., Froissart M., Lecuru F.: “Is sentinel node biopsy feasible in endometrial cancer? Result in 26 patients”. J. Gynecol. Obstet. Biol. Reprod., 2005, 34, 768.

[5] Raspagliesi F., Ditto A., Kusamura S., Fontanelli R., Vecchione F., Maccauro M., Solima E.: “Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a feasibility study”. Am. J. Obstet. Gynecol., 2004, 191, 435.

[6] Niikura H., Okamura C., Utsunomiya H., Yoshinaga K., Akahira J., Ito K., Yaegashi N.: “Sentinel lymph node detection in patient with endometrial cancer”. Gynecol. Oncol., 2004, 92, 669.

[7] Maccauro M., Lucignani G., Aliberti G., Villano C., Castellani M.R., Solima E., Bombardieri E.: “Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTclabelled albumin nanocolloid in endometrial cancer”. Eur. J. Nucl. Med. Mol. Imaging, 2005, 32, 569.

[8] Gien L.T., Kwon J.S., Carey M.S.: “Sentinel node mapping with isosulfan blue dye in endometrial cancer”. J. Obstet. Gynaecol. Can., 2005, 12, 1107.

[9] International Federation of Gynecologists and Obstetricians. Uterine corpus cancer staging. Int. J. Gynaecol. Obstet., 1989, 28, 189.

[10] Fédération Nationale des Centres de Lutte contre le Cancer. Standards, Options et Recommandations (cancers de l’endomètre, stades non métastatiques). Paris: John Libbey ed: 2001 Fédération nationale des centres de lutte contre le cancer (FNCLCC).

[11] Frumovitz M., Bodurka D., Broaddus R., Coleman R., Sood A., Gershenson D. et al.: “Lymphatic mapping and sentinel node biopsy in women with high-risk endometrial cancer”. Gynecol. Oncol., 2006, doi 10.1016/j.ygyno.2006.07.033.

[12] Barakat R.R.: “Laparoscopically assisted surgical staging for endometrial cancer”. Int. J. Gynecol. Cancer, 2005, 15, 407.

[13] Mariani A., Webb M., Keeney G., Podratz K.: “Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer”. Gynecol. Oncol., 2001, 81, 100.

[14] Mariani A., Keeney G., Aletti G., Webb M., Haddock M., Podratz K.: “Endometrial carcinoma: para-aortic dissemination”. Gynecol. Oncol., 2004, 92, 833.